Truss for prolapsus uterus



UNTE

STATES Y PATENT erraten.

WM. REYNOLDS, OF CAMDEN, SOUTH CAROLINA.

TRUSS FOR PROLAPSUS UTERUS.

To all whom t may concern Be it known that I, WILLIAM REYNOLDS, of Camden, district of Kershaw, and State of South Carolina, have invented an instrument for affording an easy, natural, and effectual support to the abdomen, back, and perineum in every instance where an artificial agent is required fo-r such a purpose, called Reynoldss gerenteron or visceral supporter,77 which is described hereinafter, reference being had to the annexed draw ings, making part of this specification.

Of all the various contrivances which have been brought before the notice of the profession and the public for the above pur pose not one of them has been found in practice to have sustained the character bestowed upon them by those interested. Useful some of them undoubtedly are in certain isolated cases; but so defective in the main points as to render their general utility very questionable, as will be shown hereafter. Now, the question may be asked at the outset, is there an existing necessity for such an instrument as the above purports to be? The whole medical profession (in the southern part of our country, at least,) will give an aflirmative answer. The nature o-f this climate, the habits of the people, where the two extremes of indolence and labor meet, are fruitful sources of those affections which beget a necessity for the above instrument to be widely diffused and placed wit-hin the reach of all, and that the inventor of the gerenteron, who has tested its advantages in his own practice, may be enabled to do this, he is induced to present it for the protectionof a patent as the only mode in which this can be successfully done and he be remunerated for the expense and trouble to be incurred.

The inventor will now proceed to point out the defects of other instruments as he has found them, and the advantages off his own, which he does, without a wish to disparage what the ingenuity of any one has effected in this way. Before doing so it must be remarked that an artificial agent to support the abdomen should assimilate as nearly as possible the natural action of the human hands when they are applied to the lower part of the abdomen for the purpose of lifting up its contents. This will be admitted by all, and it was from frequent observations of the propensity which those who labor under certain affections have of constantly applying the hands in the Inanner alluded to that first suggested what the true nature of such an instrument ought to be. The instrument known by the name of utero abdominal support has in someintice of the inventor, but its defects are these:

of, for the spring passing in a horizontal di,- rection around one hip presses the abdomen too much in an antero posterior direction, or from before, backward; the bowels are thus reinoved'from the pubis (their natural support) and brought immediately over the longest diameter of the pelvic cavity; consequently, under such pressure, a portion of them must be forced downward into that cavity as well as up toward the diaphragm. This effect is of an injurious tendency where displacement, or organic disease of any of the pelvic viscera exists. The fro-nt pad of the instrument referred to is defective because it is not divided in the center, so as to yield readily to the gradual enlargementof the abdomen in cases of pregnancy. It does not support the sides of the enlarged belly at the same time that it presses it from before backward. Such an instrument, suitable for the early months o-f pregnancy, must be laid aside and one, or perhaps more, of a larger size obtained before gestation is completed. On theother hand if such an instrument is only procured for, say the last two months of pregnancy, it is too large and of all others the female most needs an easy and proper support to the now flaco-id abdomen as a protection against a falling down of the womb, to which she is peculiarly liable at this period; especially if compelled to return soon to domestic duties. This '(it unfortunately happens) is too often the case, giving rise to. a long train o-f ailments which a suitable support at a proper time might have prevented. The back pad lof the utero abdominal supporter is found in most instances to produce a painful pressure across the spine, unless an additional padding is placed beneath it; but then the `bulk becomes inconvenient and objectionable. Females may overcome this objection, but males are deprived 'of its use where they require something of the kind not only on this account but by reason of the unneces- There is also an insurmountable objection stances afforded partial relief in the prac-Y entirely useless after delivery, the time when.

sary bulk of the center o-f the front pad..

It does not possess the lifting action spoken to the pad or compress on the perineal strapl VWomen with prolapsed uteruscannot-sit downV uponV it on account Vof its unyielding nature; and the strap itself usually presses the extremity of the Vspine (the os coccygis) so much as even, when the pad has been withdrawn, to become a serious inconvenience while the patient is in the sitting poships.

ture. Patients are Yalways found to complain also that the lower points yof the front pads of ythis instrument pressing the groins Vtoo much while in the sitting posture very Voften prevents their stooping forward; This isvca'used by the str ap dragging the instrument down,-it having no'support over the to say anything. They all press the abdomen backward and of course are objectionable. There is another.V instrument, or ratheran article of dress, which has fallen beneath the notice of the subscriber, purporting to be an effectual cure for prolapSus uteri. It is a female corset withza `compress forthe lower part of the abdomenextended from it.

Now, when it is recollected that the use of the corset i is a prolific source of this disease, what practitioner could recommend such a resort to his' patient? The corset is, in fact, one of the greatest obstacles the physician has to contend against in the cure of this disease. He aims to elevate the prolapsedorgan to its lost position, Vandto keep it there; but the corset, forcing down the abdominal viscera, counteracts his efforts. Here too 1n this instrument also males are debarred'a participation in its use.V

Few men indeed could be found'who would be willing to adoptV it if laboring under hernia. worse than useless. Ina late Vmedical journalthere is something said Vof an improve-V` ment 1n Hulls apparatus by someone in Philadelphia, and the instrumentis rec-` ommended for trial. Theimprovement (a very doubtful one) consists in afiixing coiled Vsprings to the front pads and straps of Y' erally and the desired eHI'ect will belost. i v l 'Y Hulls c instrument whereby Vit is rendered very easy. Too much so it is to be feared,

for these elastic straps will of course weaken the supporting power of the instrument genuThev invent-or will now proceed to point out the advantages of his own instrument which hezdenominates the gerenteron. A singleV glance at the'form of the instrument will convey to any observer the strict correspond- Heo ence which it bears to the osseous walls of Vthev pelvis and the natural diameter of the upper strait of that cavity; `.If the back pad is held in one hand in the positionwhich "fit takes when applied to the body steadily (the lower end slanting a little backward) andthe lower edges of the front pads, after the two are strapped together, are caught Ofj the various belts which have ap peared from time to time it is unnecessaryA It is an unscient-iflc contriv'anc'e and with the other hand, andfdrawn forward and downward from the back pad tosuch a distance as might be about its position when applied, its true action will at once be man1- fested by allowing the hand holding the front padtogbe carried backward and forward to and from thebackpad which is the fixed point.

It will 'then be observed that the lifting action is in the direction of a line drawn from the under part of the front pads to the point of attachment of the springs onthe upper part of the back pad.

The nature of the attachment at 'this point may next be examined. The freedom of mo- -tion given to the springs there, is all important for if the springs and pad be held firmly together at the point where the springs pass over the edge of the padfwith a finger and thumb of each hand, while another person draws the frontpads forward AttentionV is next solicited tothe construction of the back pad, the vertical hinge of whichrhas. these advantages: It permitseach side to fold down so as readily to adapt itself one'ach side of the spine to an emaciated habit, as is generally the case where some of the diseases to which the gerenteron is applicablehaveexisted for a lo-ng4 period. lBy this arrangement a very slight padding only is required as `the spinous ridgeissnugly lodged and protected beneath the Ahingefand this recess may be'increased' to any degree, intwo ways, either by increasing the padding on each side ofit, or by raising the/plate at this part previous to covering it. The pad partakes of the shape of the sacrum and is `so extended as to: diffuse the pressure: and render it very `comfortable. TheV front pads are light and vowing to their raised form and extensive surface have also the pressure well diffused and are consequently very easy.V The lower edge of each is cutout thatthe os pubis may not receive pressure, and such as are extended formale subjects canvhave a slight hollo'w kon the under surface Vof the plates to correspond with the course of the spermatic cord 1n its passage from c the abdominal ring toward the scrotum, so thatno undue pressure may fall upon it. A most important desideratum likewise consists in having two pads for the front instead of one, because,

`any shape of the back there, whether the c patient be of a muscular habit ofibody or of as in the case of pregnancy, or otherwise, asv

the abdomen enlarges the pads recede from each other, while a broad strap or straps (elastic or otherwise) passing from one to the other always maintain an equable support over the entire surface of the abdomen. The gerenteron has also this advantage: The same instrument can be applied immediately after accouchment, which was worn during gestation by a simple change of the front connecting strap. Further, in certain cases where no pad can be worn over the abdomen, as often happens from some natural superficial disease, or vwhere it is necessary to keep up an artificial one, such as by setons, or issues, blisters, an eruption from tartar elnetic ointment, &c., here in such cases where from combined disease of the pelvic viscera it is important to have the perineum well supported, the gerenteron at once effects the purpose in the most effectual manner. It will only be necessary, in such case, to increase the length of the front attachment of the perineal, or crotch strap, attached to the back pad, from which the long springs, and the front pads, have been removed and to have their place supplied with two very light ones of a length only sutlicient to clear the hip bones. In this way the support of the perineum is thrown altogether on the part best able to bear it-viz., the back and loins, while the abdomen suffers no pressure, the front straps alone passing over its surface to be secured above to the short springs. Attent-ioi` is also requested to the perineal straps with its appendages. 1st, the perineal pad, having an elliptic steel spring in its center, does not incommode a female in the sitting posture, and when the body is erect an ample force is constantly exerted against that part. The soft, Hat sponge attached in a situation corresponding to the vulvae and labia pudenda, absorbs the discharge, which accompanies diseases of the uterus, urethera, vagina, &c. Its mode of attachment is convenient for the purpose of ablution and covers the opening of the pocket containing the pad in such a way as to protect the pad from being affected by the discharge. The tapes which tie down the free edge of t-he pocket also aid in this. The two sho-rt pieces of the elastic strap at the extremity which buckles to the back pad, are placed there so that there may be a very slight yielding while the patient is in the sitting posture. There is a space between these two pieces which is not without its object. The extremity of the spine lodging between them is relieved from the pressure which a broad strap passing over it produces. This instrument is likewise easily modied for the cure of inguinal or scrotal and umbilical hernia. It has this advantage that ,while the large pads support the abdomen generally, any degree of pressure can be made on a particular point by the addition of a small pad and spring to suit the case.

The spring may be of any desired strength and the pad of hard or soft material. When a rupture occurs on one side and a truss is applied there, of course a greater strain is thrown upon the other situations. Nhere hernia occurs, and there is often a constitutional tendency to rupture in some persons, this pressure at o-ne point may produce a hernia at other places by throwing the weight of the viscera upon them. Now, the gerenteron7 supports the whole abdomen,

'whether there be one or more of these additional pads. Then the gerenteron is used for hernia 1n males, any common st-rap will answer for the crotch. When used by Y them as an abdominal support alone, as in corpulency, or as a protection against hernia, a strap will be seldom necessary, as it will retain its posit-ion in most such cases without one.

The physician will at once perceive that the gerenteron is almost unlimited as to the cases where it will be serviceable. An enumeration of some of them will not perhaps be out of place here. In all diseases of the organs contained within the pelvis, whether' of the uterus, ovario, bladder, or rectum; in hemorrhoids, or piles, prolapsus of the uterus, or lacerated perineum, &c.; in the abdominal aections, as where the belly is pendulous from various causes, such as enlarged ormentum, enlarged liver, spleen, &c.'; in certain dropsies; also, in hernia, in articial openings; as a support in certain conditions attendant on gestation, and after parturiti'on, as a protection against falling womb; as a support to corpulent persons or those who ride much on horseback. In all such as these its utility is clearly indicated producing an eliiect which no other instrument known can produce.

To enable others skilled in the art, to construct the gerenteron,7 I will now proceedA to explain more particularly the mode in which it is done, having reference to the annexed drawings, .as occasion may require.

Figure l represents the outer surface of the back pad plate without any covering drawn, of an ordinary size; Fig. 2, one of the plat-es'of said back pad; Fig. 3, outside washer; Fig. 4, swivel which receives the end of the spring; Fig. 5, screw pivot passing thro-ugh swivell and spring; Fig. 6, convex washer put on the end of the swivel; Fig. 7 one of the front pads; Fig. 8, under side of ditto; Fig. 9, edge view of clasp; Fig. 10, screw and nut for attaching end of spring to front pad plate; Fig. 1l, one of the loops for the straps; Fig. l2, one of the hip springs connecting the back and front pads; Fig. 18, the perineum pad; Fig. 14, a longitudinal section of ditto showing the elliptic spring inside of it; Fig. represents one l of the springs partly coveredand partly un,-

covered; Fig. 16, perineal strap and apl pendages which is to be attached to the back 'and front pads and to which the perineal pad is att-ached, also a vaginal sponge. Fig. 17 is a. perspective view of the before enumerated parts put together and finished forl y gures.

. formof a heartwith the point cut off.' The' Vpurpose to be seen hereafter.

The instrument consists of two front l pads, one `of which is shown at A, Fig. 7,

`connected to a back pad B by two springs of steel D and a strap E, for Isupporting the perineum, &c.

First of'the pack pad B. This pad is formed vof two pieces of tinB B about the size of the drawing, somewhat egg shaped. They are united by a simple hinge F throughout their whole length, when thus united they should present somewhatV the broad end will be the upper part of the pad. A row of small holes G `are now to be punched out on eachside of the hinge each row `at about E an inch distant from it. The holes to be about 9,; or `inch apart for the If Vfound to be more convenient the holes may.4 be punched before forming the hinge, they are to be large enough to admit the passage o-f a strong needle and thread through them. The hinge 'and al portion of the plate-say half an inchon each side of it, is now to be raised a little soas to leave a recess on what is intended for the under side, that the spine may be safely lodged therein. It is to be raised more at the upper part than below where in fact it need be but` little raisedfat all. If it be raised at the upper part so 'that about el the thickness'of the thumb may lie in it, it will be enough. Two loops H for the attachment of theperineal straps are now to be soldered( on the lower'ends of theV plates. Two swivels I for the .attaching of the springs D and their washers J," K are now to be procured, but before'proceeding farther take .a strip of strong buckskin about 2 inches wide and twice the length of the hinge; place one end of it at the lower endl of the hinge, hold it there, 'carry the strip upthe hinge on the outside and down again on the inside to the point where you started with it, stitch it there with some strong material by passing the needle through the holes already made. VA hole large enough to admit with freedom the stem of the swivel., is now to be made in each plate about of thelength from thetop 'and about midwayr Similar letters refer to similar parts `in the a between the hinge and the'outer edge. A piece of leather is now to Kbe laid over the outside surface, large enough to admit of having the padding stitched to it, all around,

a hole isto be made through the leather corresponding to that last madein the plate for the swivel, the outside washer J is now to be laid` on l the swivel, passed i through and riveted over Aa smallerV washer K on the under surface. Care must be taken here that the stem L is notbeatendown too much.

The swivel must have a rolling motion as portion of the padding to project at the `lower ends under the spot where the buckles M will be fiXed Two buckles M arenow to be attach-ed to the loops at the lower end. The vback pad is then finished. p

`Next of the front pads A A. `These are also plates of tin raised` to` suit the form of the abdomen. vAfter being thus raised the edges are to be turnedback slightly or they would be likely top ress'the skin too much.

.This must `be done `more particularly along the lower and outer edges and; atr the latter part `will be advantageous to turn the edge back nearly an inch, `Itwill also beproper to raise `these plates `as at `N, when `constructedffor the use of males, that the spermatic cord, in its passage, be not pressed upon. It will be somewhat like the raising of the hinge in the back pad, but need only be slightly raised in this instance, the broadest part of the hollow will be at the lower edge andfnarrowing thence for a couple of inches. lThe loops() forthe straps are put on herev asinthe other. `The pivot P for .thev `front springis then riveted to its place.

Holes R are made for the buttons, and the rivets S of the clasp Q.` The leather covering is then put` over it; the buttons passed through, .the clasp `put on and its rivets passed through the leather `and plates and the whole riveted `on the under side as before explained. ,The lclasp' under which the spring` slides, should have several holes T through forthe'passage ofa pin to hold the springs when necessary more toward the front. of the abdomen-so that they shall not press the hip bone when they passabove it. On'these. pins aresmall threads to be cut which shall screw" into corresounding holes in the plates U. beneath them-and that they may hold the better a piecezof doubled tin should be "soldered on the plate where the holes are to be, and further these holes should be punched and tapped'before the leather .is put on. For the construction of the springs D so much does not depend upon the material used, as upon the form given to them. The common material used for trusses will answer very well but it should be tinned to protect the springs from corrosion. The form, however, is all important. They should ascend from the pivots I on the back pad upward, outward, and slightly forward for a short distance until they arrive over the hip; they are then to pass along the side a little and when they arrive at the front part of the hip bone they should be brought a little toward the umbilicus or navel, so as to clear the ex treme point of that bone; then turning downward and receiving as they pass along the exact shape of the front pads, terminate within an inch or two of the bone at the lower part of the belly, called the rubis.y

The springs will, of course, differ in length, width and thickness according to the size and age of the patient by whom they are to be used. A few holes may be made on each end of the springs for the more convenient adjusting of the pads and when necessary they may be cut off between these holes by those who may not find it convenient to have an instrument constructed expressly for themselves. The springs are to be covered in the usual manner.

The perineal pad W is made in the following manner: This pad is made hollow and has an elliptic spring X in the cavity thereof for the purpose before mentioned. The elliptic spring X is composed of steel such as is usually employed in the construction of musical boxes, about linches long, about one inch at the swell. No stuffing should be placed within the ellipses of the spring. Wadding laid on theoutside of the spring and secured there with thread passed around it as shown in Fig. 16 does very well as a padding. Over this a few folds of oiled cloth, which will cover the whole, will protect the spring from rusting, finally it may be covered with leather or linen. An oil cloth pocket for containing the pad furnished with pieces of tape for tying it se cures the whole. The pad is also furnished with a piece of tape for drawing it from the pocket. It is attached to straps Z by which the perineal portion of this apparatus 1s attached to the abdominal pads in front and to the back pad behind. The straps may be of leather or of elastic materials -where that is desirable and may be furnished with coiled springs about half an inch long to ield when sitting.

That part of the strap which corresponds to the labia pudendi is covered with a fiat soft'sponge a to absorb the discharge which accompanies this disease generally. The

may be made of linen and furnished withy coiled springs b b. The part of the strap E between the principal pad and the coiled springs should be slightly padded, which part corresponds to the anus. Y

In the formation of the gerenteron as it is modified for hernia', there is no diference from what is already described, except that it has in the front pads a slit or narrow opening f, through the plate,vleather and padding for the passage ofthe spring h of the small hernia pad which as is'shown in the drawing, is to be secured on the outside or front of the large front pads byy a pivot, screw, and nut in the same way that the main o r body spring is attached. There is rlikewise a difference in the form and situation of the clasp as shown in the drawing. d is a screw and nut as before -described; we, the spring with extra holes for better adjustment; f; the opening -through which the hernial spring passes; g, an edging of sheet brass surrounding the slit and riveted there over the leathercovering; l1., the. spring of the hernial pad where it passes out from beneath; i; nut and screw sameas d, but rather smaller; k, a nut and screw to attach the spring of a small pad when used for umbilical hernia; Z, the clasp through which the main spring passes.` One half passes over the spring and constitutes the clasp. The other goes below it and it is this part which is secured to the plate with two or three rivets.

spring. That part which passes over the spring has holesV fo-r a pin to graduate the position of the spring as heretofore set forth in a previous part of the description of this instrument.

Direct/oas for application-There is no difficulty in the adjustment of the gerenteron. The upper part of the back pad rests at the small of the back, from whence it extends down `the Sacrum. The front y It also serves to pro-V tect the leather from the friction of the pads take their position without trouble,.

the lower edges of them extend down toward the pubis, The springs lie over or above the hip bones along the sides. The

pin in thc clasp7 removes them more or less from the anterior point o-f the hip bone. The pads are secured in front, by the straps there for that purpose. The crotch strap Y directions.

is lbuckled to the back pad, so that the perineal pad shall; rest exactly `under-fthe space called the perineum, which extends from the anus to the vulva. This strap is then brought up in frontand attachedby its two loose ends to the buttons on thefront pads. The. springs can be lengthened or shortened by changing the pivots from oneA hole to another at each end ofthe springs,

and where it becomes at any time vnecessary to do so, -aportion of the spring may be cut off between the holes. Y In applying the modification for hernia in the male subject, the nut which retains the small pad firmly on the large one,'is to be taken olf andthe true relation of the small pad to the abdominal ring ascertained7 lengthening or shortening it, ormovingrit,

to either side, VVbefore again Iscrewing down `When the proper situation V1s the nut. found the nut is to be screweddown very tight, and the instrument put on`as` above described, save that finsteadvof the padded crotch strap forfemale use any common one will"ans'wer, if. indeed the patientu vrequires one at all. to .one side, of course only one `of the front pads need have the hernial pad.V When usedV for i umbilical hernia any oneVY will underfA stand how it ismto be Vap lied on looking at theY instrument' andreadlng the foregoing That modification''wherein the short springs are adapted instead of the vlong ones and 4which hasno front pads, is

also so simple as to require nofurther directions.` A Q lThe inventor. desires to enter an obJection against any infringement onfthis pat.` ent by Aaddingza corset to the .gerenteron,

because, itjwould detractv from its eflicacy and because if necessary, 'itican be done in a variety of ways which suggest themselves to the inventor.- Something attached to the upper part of theback pad by elastic straps, which would lace around the chest, so as to support the breasts mightV be useful and can be added where it is desirable to Vdo so, but against any thing descending in front below the sternum the inventor most stren- When the rupture is confined ifieo uous'ly protests. The inventor is aware that a spiral spring `in the padding of the front large pads, 'as a substitute for his smallv hernial pad and spring, Vmightbeadopted;`

but he believes the latter to answer the purpose best. He is also aware that a wedge sliding behind the spring of his small hernial pad, or the action of a screw against it, would conveniently control its power; but he considers such additions` unnecessary complications. He is aware that all `the straps may be constructed with"` coiled springs or gum elastic material and that eventhe pads also may be thus constructed,

and therefore he objects to such innovations, believing them unnecessary in a general point of view, but where required they can be so'k constructed.

What I claim as `my invention, and which I` desire to secure byfLetters Patent, con- .sists- Y l. In constructing the back pad plate a` little raised on each side ofthe center so as Vmanner set forth.

The mode olf-adjusting the hip springs bymeans of the clasps andpins on the front pads as described,L f

4. .The mode ofl adjusting the front pads so `as to adapt them to any sized abdomen by the Vmeans described, or any other mode `substantiallythe same.

5. The construction of the pad for supporting the perineum with an Velliptic `spring in the centenas described. i

. REYNOLDS.

VVitnessesz'` WM. P. ELLIOT, t EDMUND MAHER. 

